I desperately need some feedback. I offered two 4 hour Part 2 skills check off NRP courses yesterday. The morning one was comprised of our new maternal-infant nurse interns. I must say, it was the worst NRP course I've ever had! We currently offer a high fidelity simulation lab experience that allows the group to have actual feedback from the "baby" and also to practice working as a team. To be blunt, both groups in the first class killed the baby. They had already been through simulation stations with experienced NRP instructor/mentors. It had become apparent that, despite having their books for about 12 weeks, they had only studied enough to pass the written exam. We have never made this piece of the course a pass/fail. All of the instructors there yesterday discussed this and have, so far, felt like this should have been a graded section. I'm wanting to know what others are doing? I'd love your suggestions, ideas, etc.

Did you do multiple scenarios? If so, did they do poorly on all of them? IF they are totally unprepared it is better to have them fail the class and have them retake again, then to pass someone who doesn't know what they are doing. They may need some practice simulations before taking the actual class. We usually run through several practices, starting with bagging and chest compressions. Then we will do a few basic scenarios and discuss them. Last we do several full mock codes to check their competency and debrief again.

We do the same thing but these girls came totally unprepared for class. I am suspicious (but cannot prove) that they did the online exam as a group activity based on the date that they completed it and the low scores that each of them had. Their books "cracked" like new books that have not been opened did. This was a group of new interns who have had some behavioral problems since they began their internship. One of the participants actually stopped doing compressions on a baby with asystole to push the person assigned to meds out of the way and gave the meds herself. They had just finished arguing over what dose of epi to give and settled on a 6 mL dose and flushed it down the ETT with 20 mL of NS. There is a laminated copy (both small and larger on the wall) of the algorithm along with MR SOPA. Same intern told her preceptor the next day that she'd never heard of a neo-puff nor had she seen one. (That is part of our respiratory station!). The only other class I've had that was this bad was a very experienced group who did not study but did ok in the practice scenarios and mega code testing. They failed the hands on high fidelity exercise. They spent 10 minutes trying to find a pulse . . .

For those that are new or have little or infrequent experience with resuscitation, I usually layer the class starting with a scenario that requires drying, stimulating, and maybe O2 use or a quick response from PPV then I add scenarios building on this until they are using all aspects of resuscitation (intubation, chest compressions, meds, and lines) getting more complicated each time. By the the time we get to the end they are usually ready for a competency with debriefing. Our NICU staff are completely bored with this type of class so we do complicated scenarios using all aspects from the beginning and check-offs on their skills are done at their Ed day twice a year.

I do use multiple scenarios and we pick and choose as well as layer pieces in depending on the experience level or site where the person works. However, I am wondering if anyone uses high fidelity simulation along with the mega-code and do a pass/fail for both or just the mega-code. I had two groups of new graduates last week that met (just barely) the minimum critical elements to pass the mega-code but would have failed the team exercise with the high fidelity manikins if it were a "graded" piece.